Basic Information
| Provider Information | |||||||||
| NPI: | 1942685292 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTHARI | ||||||||
| FirstName: | VALLARI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | DERBY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064181328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037321256 | ||||||||
| FaxNumber: | 2037321539 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 DIVISION ST FL 1 | ||||||||
| Address2: | |||||||||
| City: | ANSONIA | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064012135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037353500 | ||||||||
| FaxNumber: | 2037350505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 11/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 64301 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 64301 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.